Search PubMed⌕ Search

Biomedical subjects

L Dominioni

Publications and source records attributed to L Dominioni.

64 records · Page 4Linked to original sources
PubMedDate not supplied

Optimal lipid content for enteral diets following thermal injury.

This study was performed to determine the effects of different amounts of lipid in enteral diets during the postburn period. Forty-five guinea pigs with catheter gastrostomy received a 30% total body surface area full thickness flame burn. After burn they were given intragastric tube feedings using five diets at different dietary lipid composition: 0, 5, 15, 30, and 50% of nonprotein calories. Total calories administered (175 kcal/kg/day), protein content and composition (20% of total calories), total volume, and vitamin and mineral content were constant in all animals. At postburn day 14, body weight, carcass weight, and muscle weight were the greatest in 0 and 5% lipid groups, and the least in 30 and 50% lipid groups. Serum transferrin was highest in the 5 and 15% lipid groups, and lowest in the 30 and 50% lipid groups. Total nitrogen content in muscle and cumulative nitrogen balance were best in the 15% lipid group. Liver fatty infiltration, caused from a larger proportion of carbohydrate administration, was greater in the 0 and 5% lipid groups and less in 15 and 30% groups. It is concluded that dietary lipid levels between 5 and 15% of nonprotein calories are optimal for nutritional support after burn injury. The nutritional management of postburn patients with higher levels of dietary lipid should be reconsidered.

Animals↗
PubMedDate not supplied

Enteral feeding in burn hypermetabolism: nutritional and metabolic effects of different levels of calorie and protein intake.

Enteral nutrition was provided by continuous pump-controlled gastrostomy tube feeding for 14 days in 97 guinea pigs bearing a 30% full thickness burn. Seven defined combinations of caloric and protein intake were studied. With a caloric intake of 175 kcal/kg/day, equaling the measured energy expenditure, the animals receiving 10% of calories as protein had a significantly greater postburn weight loss (p less than 0.05) and muscle mass depletion (p less than 0.05), and a significantly lower muscle nitrogen concentration (p less than 0.05), serum albumin level (p less than 0.01) and liver nitrogen content (p less than 0.01). With the same caloric intake but with more than 20% of calories as protein, the weight loss and the muscle wasting were reduced, but not abolished, and the serum albumin level and liver nitrogen content were normalized. Also with the diets containing 200 kcal/kg/day the muscle tissue depletion could not be abolished. However, with this caloric intake, the animals given 20% of calories as protein had a lower weight loss and a higher serum albumin level (p less than 0.01), but also a greater fat infiltration of the liver (p less than 0.01). At both levels of caloric intake, the nitrogen balance correlated significantly with the level of nitrogen intake but did not correlate with the changes of body weight. The incidence of diarrhea was lowest in animals fed 20% protein calories at a caloric intake of 175 kcal/kg/day. All things considered, the best metabolic and nutritional results were obtained with diets containing 20 to 30% of calories as protein and providing a caloric intake that paralleled the measured energy expenditure.

Abdominal Muscles↗
PubMedDate not supplied

Intact protein versus free amino acids in the nutritional support of thermally injured animals.

This study compared the nutritional effects of intact protein with that of constituent amino acids as the sole source of nitrogen in a burn guinea pig model. Forty-five guinea pigs bearing a gastrostomy feeding tube were given 30% total body surface area, full thickness flame burn and were randomized into four groups. Group I (n = 12) and group III (n = 15) received a diet containing whey protein, while group II (n = 9) and group IV (n = 9) received an otherwise identical diet containing free amino acids in a whey protein pattern. Full strength continuous intragastric feeding was initiated immediately postburn in groups I and II, but a 72-hr adaptive period was provided in groups III and IV. Resting metabolic expenditure was measured by indirect calorimetry on postburn days 2, 6,9, and 13. After 14 days of enteral feeding, the animals were killed. Immediate enteral feeding of intact protein or free amino acids reduced postburn hypermetabolic response (p less than 0.01). However, the intact protein was found to maintain body weight and provide nitrogen retention better than the amino acid mixture (p less than 0.05). The animals on the intact protein diet also showed statistically significant benefits in carcass, liver, and gastrocnemius muscle weights and in serum albumin, transferrin and C3 levels. It is concluded that intact protein is superior to free amino acids for nutritional support following burn injury.

Amino Acids↗
PubMedDate not supplied

Immunological function and nutritional assessment.

Theoretically, a large number of tests of immunologic functions could be used for nutritional assessment. However, many of these immunologic tests require specialized laboratory skills and take a long time to perform. These tests provide little additional information to the clinician concerning the nutritional status of the patient, compared to the data that can be obtained from a few simple, selected immunologic measurements. Only a few immunologic tests are sufficiently simple, reproducible, and reliable indicators of nutritional status to be of practical value for routine nutritional assessment. These are the total lymphocyte count and skin tests. At present, all of the other immunologic measurements that have been reviewed should be considered as research tools for nutritional assessment. Immunological tests can be affected by many clinical variables unrelated to nutrition, such as specific pathologic conditions, immunodepressive therapies, accidental or surgical trauma, and infection, and this fact should be considered when using immunological tests to assess nutritional status. Malnutrition suppresses the acute-phase response of plasma proteins. The measurement of the acute-phase response of selected acute-phase proteins can be a functional measurement of nutritional status.

Acute-Phase Proteins↗
PubMedDate not supplied

[Antibiotic prevention of surgical infections].

Postoperative infections are the most frequent cause of morbidity and mortality in surgical patients, considerably increasing the duration and cost of hospitalization. During the past decade the criteria for the administration of prophylactic antibiotics have been established and their proper use has caused a significant reduction of postoperative infections. The Authors review the indications to the use of local and systemic antibiotic prophylaxis; moreover, the general principles of antibiotic prophylaxis are presented and discussed, including problems related to the choice of antibiotic, dosage, timing and duration of administration, under different clinical circumstances and in various types of surgical operations.

Anti-Bacterial Agents↗
PubMedDate not supplied

Infected pancreatic necrosis complicated by multiple organ failure.

BACKGROUND/AIMS: Sixteen patients with bacteriologically proven severe infected pancreatic necrosis (IPN) undergoing sequential surgical treatment were studied prospectively. METHODOLOGY: The severity of IPN was documented pre-operatively using the following scores: 1) degree of necrosis by CT scan [< 30% in three patients (19%); 30-50% in nine patients (56%); > 50% in four patients (25%)]; 2) Elebute and Stoner's sepsis score (16 +/- 4 points); 3) Goris' score of multiple organ failure (MOF) (5 +/- 2 points). Sequential surgical treatment was carried out by the same surgical team, as follows: 1) abdominal re-explorations through a zipper for the first 7-10 days; 2) open abdomen and repeated peritoneal debridements for the following 7-10 days; 3) continuous closed peritoneal lavage with multiple drainage, until resolution of infection (range: 15-85 days). No patient required further re-exploration. RESULTS: Mortality occurred in 3/16 patients (19%), due to MOF in all 3 cases. The 13 survivors (81%) were discharged convalescent with closed abdominal wound, feeding orally, after 73 +/- 33 days, without fistulae. These results indicate that by treating severe IPN with the technique of sequential abdominal re-explorations, open drainage and continuous closed lavage, a low 19% mortality can be achieved. CONCLUSION: This study provides an assessment of the pre-operative severity of sepsis and of MOF in each patient with IPN: these data could facilitate future comparison of results obtained with other treatment modalities.

Adult↗